Brain death has been one of the most controversial conversations in medicine for decades and has brought into question the characteristics of brain death and how to identify it in order to prevent cases of malpractice. We hear the phrase used very often in hospitals and tv shows like Grey’s Anatomy where Derek, the protagonist neurosurgeon, is ironically declared brain dead, and his wife must “pull the plug” to end his life. This is not an uncommon scenario in hospitals, but how can doctors tell if a patient is brain dead and when a patient is declared dead?
Dr. Vukov addressed the differences between the disorders of consciousness: coma, vegetative state, locked-in syndrome, and minimally conscious state in order to define brain death. He defined someone who is brain dead as being in a “demonstrably irreversible coma.” He defined a coma as lacking consciousness, in terms of lacking arousal and awareness. In order to be declared dead officially, there must be an absence of brainstem function and an absence of spontaneous respiration where a respirator is required for breathing. The other form of death is cardiovascular death that refers to when the heart cannot be started and is often harder to differentiate than brain death.
The discrepancies may lead to patients being declared brain dead, but are technically still alive. For example, Jahi McMath is a 13-year-old girl who went to the hospital in 2013 to get her tonsils removed, but due to complications during surgery, she was put on life support and declared brain dead after the surgery. More than three years later, her mother and family refused to take her off life support due to their strong Catholic beliefs that pushed them to believe that she is still alive. They began to notice that her finger would twitch, which is common among brain dead patients. Other evidence found in videos released during 2014 to 2016 showing Jahi reacting to odors and showing no signs of body deterioration that usually occurs once someone is dead. The most fascinating evidence for Jahi being alive is that she reached puberty and menstruation while on life support.
This evidence led to Jahi’s doctors to redefine her state as minimally conscious rather than brain dead three years later. Dr. Vukov defined someone in a minimally conscious state as being able to do some simple commands like a fully conscious person. In order to avoid misdiagnosis, we must be able to distinguish between the different states of consciousness in patients who are unconscious. It would be interesting to find out how Jahi’s body was able to continue operating while she had no brain activity. The hardest part however is being able to do research on brain death ethically and with the consent of family members. We can learn a lot from looking at scans from patients in the different states of consciousness, but finding neurological explanations for the differences can help redefine brain death and make it more easily distinguishable from the other states of consciousness.
References
“Jahi McMath, Girl Declared Brain Dead Three Years Ago, Might Still Be Technically Alive,
Judge Says.” Los Angeles Times, Los Angeles Times, 7 Sept. 2017, www.latimes.com/local/lanow/la-me-brain-dead-girl-20170907-story.html.
Powell, Tia. “Brain Death: What Health Professionals Should Know.” American Journal of
Critical Care, vol. 23, no. 3, 2014, pp. 263–266., doi:10.4037/ajcc2014721.
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